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   Table of Contents - Current issue
Coverpage
January-June 2022
Volume 6 | Issue 1
Page Nos. 1-29

Online since Friday, October 14, 2022

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REVIEW ARTICLE  

Kite string injury to the head-and-neck region: A review p. 1
Santosh Kumar Swain
DOI:10.4103/aiao.aiao_6_22  
Flying kite is a popular sport among children although many adults also fly kites in festive seasons. People frequently fly kites to celebrate the arrival of spring. These kite festivals feature a sport called kite fighting, in which competitors attempt to sever the string of a rival kite with their own kite. The majority of injuries are sustained at the time of flying kites due to falls, cuts, neck injuries, or even death. Injury to the head-and neck region by kite string is often fatal. These injuries can range from a superficial laceration to profound muscle, tendon, artery, or nerve injury. Flying kite is associated with simple injury to grievous trauma. The severity of the injury is determined by the abrasive materials used on the kite's string to improve its cutting capabilities. Injuries caused by flying kites are usually avoidable. Because the neck is frequently exposed while riding a motorcycle, this is likely the source of the high number of injuries in this area. Injuries caused by kite string can be avoided. The preventive methods include choosing a safe site and improving knowledge of the kite string's potential threats. There are not many research articles concerning kite string injury in head-and-neck area. This review article seeks to provide a complete overview of head-and-neck kite string injuries.
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ORIGINAL ARTICLES Top

Comparison of acoustic reflex thresholds across different stimuli p. 6
Neelamegarajan Devi, Ajithkumar Murugesan
DOI:10.4103/aiao.aiao_17_21  
Background: Acoustic reflex (AR) is the contraction in the middle ear muscles in response to severe acoustic stimulation. Thresholds of AR can be obtained using different stimuli and different stimulus parameters. However, the reflexes are often difficult to elicit in hearing-related disorders such as hyperacusis, recruitment, young infants, and children with autism. Comparisons of AR thresholds (ARTs) across different stimuli, such as PT, broadband noise, and clicks at different rates, can provide information on the stimuli optimally used for difficult-to-test populations. Objective: The study aimed to estimate and correlate the ARTs elicited by pure-tones (PT), the low-frequency band (low pass [LP]) and high-frequency band (high pass [HP]), wide-band noise (WB), and clicks at different rates. Materials and Methods: ARTs using different stimuli like PT of frequencies 500, 1 k, 2 k, 4 k Hz, the low-frequency band (LP) (i.e., noise in the frequency range of 125–1600 Hz), the high-frequency band (HP) (i.e., noise in the frequency range of 1600–4000 Hz), wideband noise (WB) (125–4 kHz), and clicks at different click repetition rates as 50/s, 100/s, 150/s, 200/s, 250/s, and 300 clicks/sec was measured on 50 normal-hearing individuals. The ARTs were documented for both ipsilateral and contralateral recording for all test stimuli. Results: The mean ART obtained for 500 Hz PT was between 85 and 95 dB HL, for WB, it was between 80 and 85 dB, and for LP and HP, it was between 75 and 80 dB HL. For click stimulus, a better threshold of 70 dB HL was obtained at 300/s. The mean ART elicited by PT and WB noise was higher than click stimuli. The mean comparison of the ART obtained between PT and WB revealed better thresholds for WB noise. Between WB noise and clicks, better ART was observed for click stimuli. The clicks elicited ART were better than noise stimuli followed by PT. Ipsilateral stimulation yielded better responses than contralateral stimulation for all stimuli. Discussion: The mean ART for click stimulus was better because it stimulated a wider frequency range in cochlea than PT, LP, and HP. Even though WB has a wider frequency range than clicks, the mean ART for click stimulus was much better because of a factor called temporal integration, i.e., stimulation at a higher rate (300/s). Conclusions: The click stimuli at a higher rate can be used effectively to measure ART's for individuals with lower comfortable levels as it can elicit reflex at lower thresholds.
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Sentinel lymph node biopsy using methylene blue alone in an era of significance of the depth of invasion in oral cancers: A prospective study p. 12
Subbiah Shanmugam, Sujay Susikar, Syed Afroze Hussain, T Bharanidharan, Kishore Kumar Reddy
DOI:10.4103/aiao.aiao_14_21  
Aim: To evaluate the accuracy of methylene blue dye alone in identifying sentinel nodes in oral cancers with clinically N0 neck and the significance of the depth of invasion (DOI) in combination with sentinel lymph node (SLN) biopsy in predicting nodal metastasis. Methods: This is a prospective study done over 24 months accruing 67 patients with cN0 neck admitted to our center for oncology. SLN harvesting was done adhering to the standard procedure using methylene blue dye for all early-stage oral cavity cancers with N0 neck clinically. Data were collected, grouped, and analyzed for deducing DOI, sensitivity, specificity, positive predictive value, and negative predictive value of the procedure and compared with other studies in the literature. Results: Out of 67 patients, males (76.1%) outnumbered female (23.9%) patients. The mean age of the patients was 51.5 years. Tongue (61.2%) was the most common site. Sentinel nodes were identified in 89.5% of patients. The mean number of Sentinel nodes identified was 1.9. The mean DOI was 7.3 mm. SLNs were most commonly identified in Level I (78.3%). Sensitivity, specificity, positive predictive value, and negative predictive value and accuracy deduced in this study were 75%, 97.9%, 90%, 94%, and 93.3%, respectively. Conclusion: Methylene blue dye alone can be successfully used for SLN identification in clinically node-negative oral cavity cancers, particularly with less DOI. DOI alone for predicting nodal involvement can be used with caution. Combination of DOI and sentinel node biopsy may help in better identification of nodal involvement.
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SHORT COMMUNICATION Top

Nasal vaccines for COVID-19: Current trends and future perspectives p. 17
Simran Spal, Anshul Mahajan, A Parvesh, Vipra Kohli, L V Simhachalam Kutikuppala, Tarun Kumar Suvvari
DOI:10.4103/aiao.aiao_21_21  
Coronavirus disease (COVID-19), a highly contagious viral respiratory illness, has resulted in widespread human losses, as well as posing more newer difficulties to the global health infrastructure. Vaccination has been a powerful public health tool for preventing deadly diseases, and it is still the most effective weapon when dealing with pandemics. Intranasal vaccines form an important part of the next-generation vaccines being developed to bolster our arsenal against infectious diseases. Nasal delivery of vaccines induces both systemic and local mucosal immune responses to help scale up the war against the inhaled pathogens. Owing to its simplicity, ease, convenience, safety, and higher effectivity, intranasal vaccines are turning out to be a promising alternative to the parenteral and other mucosal routes of administration. Intranasal vaccines are considered more efficacious than conventional parenteral injectable vaccines for influenza virus. The vaccination rate can be increased as the intranasal vaccine is directly delivered into nasal cavity and involves less cumbersome and painless procedure than intravenous administration. Nasal mucosa is an easily accessible organ with rich vascular supply and large surface area available for absorption aiding in quick absorption of vaccine. Furthermore, the intranasal vaccines are more affordable than the conventional vaccines.
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CASE REPORTS Top

Extensive facial cellulitis due to staphylococcal infection in young, immune-competent females p. 22
Pookamala Sathasivam, Vijay Pradap, Maheshwaran Shanmugasundaram
DOI:10.4103/aiao.aiao_5_22  
Skin and soft-tissue infections are commonly caused by Staphylococcus and Streptococcal infections. They usually cause self-limiting localized infection and responds well to antibiotic therapy. At times, they can cause dreadful infections in unfavorable conditions. Here, we discuss two cases of extensive Staphylococcal infections in healthy females. Both patients, presented with diffuse swelling of the entire half of the face. It was associated with fever, peri-orbital swelling, and swelling of upper/lower lips with multiple areas of subcutaneous pus collection. It started as a painful lesion over the cheek, which started spreading because of repeated probing of the lesion by the patients. Pus culture yielded heavy growth of Staphylococcus. In view of the massive upper airway edema, they required tracheostomy to secure airway. They were treated with intravenous antibiotics, and incision and drainage were done to relieve pus collections. They showed a dramatic response to treatment and they did not develop further complications. This article highlights the danger associated with the probing of infective lesions over the face. Young females often have a tendency to pinch acne or any other lesions over the face due to cosmetic concerns. It is essential to educate patients about the risks associated with such habits.
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Post-COVID primary laryngeal aspergillosis p. 26
Sudhakara Rao Madala, Pandiri Jagruthi, P S N Murthy, Akkineni Anusha
DOI:10.4103/aiao.aiao_4_22  
Ever since the first case reported in 2019, covid 19 has been affecting the health and well-being of people globally. Covid 19 infection, through its post recovery immunocompromised state, has opened a door for many opportunistic infections in the affected patients. Aspergillosis is one such opportunistic infection. Among the multiple species of aspergillus, the most common species causing aspergillosis are A.fumigatus and A.flavus. Like any other fungal infection, in aspergillosis, larynx is involved secondarily as a consequence of advanced stages of lower respiratory tract infection or by hematogenous spread from a primary site. Here we are reporting a case of primary aspergillosis of larynx in a 41-year-old immunocompetent male patient who has been affected with covid 19 infection twice in a span of 9 months and presented with history of hoarseness of voice.
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